Diagnosis of prostate cancer

Why a thorough diagnosis is important

If prostate cancer is suspected, several tests are required. The aim is to determine exactly:

• whether there is actually a tumour
• whether it is benign or malignant
• how far the disease has spread
• which treatment is most appropriate and what you can reasonably be expected to undergo

A thorough diagnosis is essential for determining whether treatment is necessary at all and, if so, for planning the most appropriate course of treatment.

Medical history: The doctor-patient consultation

The diagnostic process begins with a detailed consultation with the doctor. During this consultation, the following information, amongst other things, is recorded:

• Current symptoms
• Previous medical conditions
• Family history
• Medications taken

This information helps to better assess individual risk and plan further investigations in a targeted manner.

Palpation

The prostate is examined via the rectum. This allows:

• Lumps
• Knots
• Abnormal changes

can be identified. The examination is simple and relatively painless, but only provides initial indications.

Blood test and PSA level

Blood tests not only provide doctors with important information about your general health or the function of individual organs; the level of prostate-specific antigen (PSA) also indicates the possible presence of a tumour in the prostate and whether the tumour is benign or malignant.

The PSA level in the blood is an important marker. A low level often indicates a locally confined tumour, whilst a high level indicates an increased risk of cancer or an advanced disease.

Stockholm 3 Test

The Stockholm3 test is a modern diagnostic method for assessing the risk of prostate cancer.

Unlike the traditional PSA test, Stockholm3 takes several different factors into account simultaneously. These include:

• protein markers in the blood
• genetic markers
• clinical patient data (e.g. age and family history)

This information is analysed using a scientifically developed algorithm. On this basis, the risk of clinically significant prostate cancer can be assessed on an individual basis. Studies show that, compared to the PSA test alone, the test can identify clinically significant tumours more frequently whilst reducing the number of unnecessary biopsies.

Magnetic resonance imaging (MRI)

If an elevated PSA level raises suspicions of prostate cancer, an MRI scan can be used to investigate this further. An MRI scan provides high-resolution images of the prostate and helps to identify suspicious areas, enabling further targeted investigations to be planned or preparations to be made for surgery or radiotherapy. The scan is painless, takes around 20–30 minutes and involves no exposure to radiation.

Biopsy: Confirming the diagnosis

A biopsy is crucial for a definitive diagnosis. During the procedure, tissue samples are taken from the prostate; microscopic examination of these samples can reliably confirm the presence of prostate cancer. The procedure is usually performed under ultrasound guidance, and MRI images may also be used to guide the sampling.

The tissue sample is usually taken on an outpatient basis. It is only slightly painful, and mild side effects such as blood in the urine are possible.

Ultrasound scan (sonography)

If the suspicion of prostate cancer is confirmed, a transrectal ultrasound scan is used to determine how far the tumour has spread within the prostate or beyond. The procedure is painless and involves no exposure to radiation.

Bone scan

This non-invasive screening method is used to detect bone metastases. It involves administering a low-level radioactive substance that tends to accumulate in bones affected by cancer. A special imaging technique is then used to visualise these areas. The procedure should be used when the PSA level is greater than 10 ng/ml in order to rule out or detect bone metastases.

PET-CT (positron emission tomography)

PET-CT is an imaging technique used to visualise the metabolic activity of cells. Tumour cells usually have an increased metabolic rate, which makes it possible to visualise cancerous lesions. However, inflamed tissue can also have increased metabolic activity and thus accumulate more tracer. A PET scan alone is therefore not sufficient to diagnose cancer. Today, the image from a PET scan is often combined with computed tomography to form a PET-CT scan.

CT (computed tomography)

In cases of advanced prostate cancer, computed tomography (CT) is used to detect distant metastases or to investigate symptoms. A CT scan not only shows metastases, but also the lymph nodes and internal organs. It provides important information for planning surgery or radiotherapy.